Medical care insurance reform passed in Japan

The House of Councillors passed and enacted a bill Wednesday to reform the public health care system, aiming to strengthen the national health insurance programme's financial state.

The bill saw a majority vote from the Liberal Democratic Party, Komeito, the Japan Innovation Party and other parties.

Contribution percentages to the medical insurance programme for patients aged 75 and over will likely rise for health insurance societies, comprised mainly of employees at major companies. Many corporate health insurance societies are therefore expected to raise their insurance premiums.

The legislation also stipulates planned fee hikes for medical care, including meals during hospitalisation.

About 35 million people subscribe to national health insurance including self-employed, unemployed and nonregular employees.

The insurance programme continues to sag under higher costs stemming from an increasingly aging population, but insurance premium revenues have remained stagnant because subscribers have a low average income - pointing to a structural flaw.

To control the programme's billowing deficits, the bill will transfer its management from municipal governments to prefectural governments starting in fiscal 2018.

More public funding will be allocated to support the insurance programme. Starting in the current fiscal year, ¥170 billion will be provided each year and raised further to ¥340 billion after fiscal 2018.

Contribution percentages to be paid by corporate health insurance societies for the medical insurance programme for patients aged 75 and over will gradually be raised from fiscal 2015 to fiscal 2017.

But greater contributions will likely force many corporate health insurance societies to raise insurance premiums, which could mean lower net incomes for company employees.

Premiums for the Kyokai Kenpo Scheme are expected to remain unchanged because public subsidy funding percentages will not be adjusted for operators of the programme managed by the Japan Health Insurance Association, or Kyokai Kenpo, which covers employees of small and mid-sized companies.

Patients will have to shoulder more financial costs. Except for low-income earners, hospital meals that currently cost ¥260 each for inpatients will be raised by ¥100 (S$1.10) in fiscal 2016 and again in 2018 to a final price of ¥460.

The bill will also introduce a new system in fiscal 2016 that raises costs for treatment at large hospitals without referrals to range from ¥5,000 to ¥10,000, which must be covered entirely by patients.

A special measure that lowers health insurance premiums for those aged 75 and over will be abolished, in principle, in fiscal 2017. Considerations will be made for low-income earners.

Costs rise as nation grays

By Keiichiro Azuma / Yomiuri Shimbun Staff Writer

Japan's medical care expenses have soared to ¥40 trillion a year and are expected to climb ¥1 trillion on an annual basis because of the rapidly aging population.

The government has allocated more than ¥3 trillion of public funding each year to the national health insurance programme, which has many elderly subscribers.

Yet the scheme's deficits stood at around ¥310 billion in fiscal 2013 and are projected to continue worsening in the future.

Though the bill will transfer key roles in managing the national health insurance programme from municipal governments to prefectural governments, enlarging the sizes of the operators alone will do little to control the ballooning medical care expenses.

Insurance programme operators have the potential to make an impact by utilizing the benefit of having expanded coverage areas to emphasise the prevention of lifestyle diseases, as well as offering healthcare guidance.

From a long-term perspective, such measures need to be promoted to effectively reduce medical care expenses.